- IPMN is an acronym for intraductal papillary mucinous neoplasms of the pancreas. It is also called a pancreatic cystic neoplasm.
- Pancreatic cysts are typically found when patients undergo abdominal imaging for other reasons.
- An IPMN is a benign (non-cancerous), fluid-filled pancreatic cyst.
- Though IPMN cysts are benign, they can develop into malignant tumors. This type of pancreatic cancer can become invasive cancer that is difficult to treat.
Being diagnosed with IPMNs often comes as a surprise because IPMNs are usually discovered during a screening for something unrelated to the pancreas.
The diagnosis of an IPMN may feel overwhelming, especially when research via “Dr. Google” mentions how it can relate to pancreatic cancer. However, it’s important to remember that while pancreatic cysts associated with IPMN can turn into pancreatic cancer, the prevalence of pancreatic cancer associated with IPMN is relatively low. Also, early detection and diagnosis can lead to effective treatment that offsets the risk of malignancy.
Increased awareness of invasive IPMN has enabled pancreatectomies (surgical removal of the pancreas) to be performed at an earlier stage, similar to common pancreatic cancer.
What are IPMNs?
Intraductal papillary mucinous neoplasms of the pancreas (IPMN) are cysts or fluid-filled sacs found in the pancreas.
These types of cysts are benign, which means they are not cancerous. However, in 1%-11% of patients, an IPMN can be aggressive and develop into pancreatic ductal adenocarcinoma, a lethal form of pancreatic cancer. These tumors usually become invasive cancer, move into the lymph nodes, and are difficult to treat.
Even though they’re benign, don’t ignore IPMN. Schedule and attend follow-up appointments as your medical practitioner recommends.
About the pancreas.
Your pancreas is an organ in your abdomen that is located behind your stomach and directly connected to other major organs in your digestive tract.
A key part of your digestive system, your pancreas produces hormones that regulate various bodily functions and digestive enzymes that help your body process food.
There are four main parts of the pancreas:
- The head of the pancreas
- The neck of the pancreas
- The body of the pancreas
- The tail of the pancreas
The pancreas has a main duct, sometimes referred to as the main pancreatic duct, which has several branches. The digestive enzymes produced by your pancreas move through the branches, into the main duct, and into the duodenum (small intestine).
As previously mentioned, the pancreas also produces essential hormones vital to many digestive and metabolic processes. Some of these hormones include insulin and glucagon. Both are important for regulating your blood sugar levels.
Key acronyms related to IPMN.
There are many acronyms associated with IPMN. Use this list as a handy reference whenever these terms come up during your appointments:
- IPMN: A non-malignant cyst in your pancreas. There can be a singular IPMN or multiple IPMNs.
- BD (branch duct): The side branches of the main pancreatic duct
- CEA (carcinoembryonic antigen): A set of highly related glycoproteins involved in cell adhesion. Elevated CEA levels (3 ng/mL or higher) are considered abnormal and could indicate cancer.
- ERCP (endoscopic retrograde cholangiopancreatography): A technique that combines the use of endoscopy and fluoroscopy to diagnose and treat certain problems of the biliary or pancreatic ductal systems
- EUS (endoscopic ultrasound): Endoscopy combined with an ultrasound to obtain images of the internal organs, including the pancreas
- FNA ( fine needle aspiration): A diagnostic procedure used to investigate tumors or cysts
- HGD (high-grade dysplasia): Pre-cancerous changes in the cells. Moderate to severe dysplasia is considered high-grade.
- LGD (low-grade dysplasia): Mild to moderate dysplasia
- MRI (magnetic resonance imaging): An imaging technique in radiology used to create pictures of the anatomy and the physiological processes of the body
- PCN (pancreatic cystic neoplasm): Fluid-filled sacs (cysts) within the pancreas. Pancreatic cystic neoplasms (PCN) include different types of cysts with various biological behaviors. The most prevalent PCNs are IPMNs, mucinous cystic neoplasm (MCN), and serous cystic neoplasm (SCN)
- MRCP (magnetic resonance cholangiopancreatography): A medical imaging technique that utilizes magnetic resonance imaging to see the biliary and pancreatic ducts in a non-intrusive way
- PDAC (pancreatic ductal adenocarcinoma): A very aggressive malignancy that is usually lethal, mainly because of the failure to diagnose it early
Types of cysts, tumors, and lesions that affect the pancreas.
A cyst is a formation of cells that make a sac. The sac may be filled with fluid, air, or solid material.
There are various types of pancreatic cysts, tumors, and lesions. These include the following:
- Fluid-filled cysts are called cystic neoplasms.
- Pancreatic cystic tumors are tumors in the pancreas containing fluid that could be either serous (watery-like fluid) or mucinous (mucus-like fluid).
- Cystic lesions are a group of pancreatic lesions characterized by a cystic appearance. They can be benign or malignant.
There are different types of pancreatic cysts, but the most prevalent two are serous and mucinous. These are different from IPMNs.
An IPMN is a mucinous cyst characterized by its viscous fluid. IPMNs develop inside the main pancreatic duct and its branches. Some IPMNs reach out into the pancreatic duct system or branches of the duct. These are called branch duct IPMN.
All types of pancreatic cysts are typically found when patients receive abdominal imaging for other reasons. For example, a radiologist could see a pancreatic cyst when they’re looking at a gastric ulcer.
A study done by Johns Hopkins showed that, as we age, we are more susceptible to pancreatic cysts.
This same study also found that many people (2.6%) who had IPMNs were asymptomatic.
Risk factors for IPMN.
One study published by Roberto Salvia and Claudio Bassi, among others in the American Journal of Gastroenterology, looked at the environmental, personal, and hereditary risk factors associated with the occurrence of IPMN.
They found that people with a history of diabetes and insulin treatment, a family history of pancreatic ductal adenocarcinoma (PDAC), or chronic pancreatitis (CP) have an increased risk factor for IPMN.
Signs and symptoms of IPMN.
Usually, people are unaware that they have an IPMN because there aren’t any signs or symptoms.
An IPMN is generally found through imaging tests that look at other parts of the endogastric system. This is why regular, preventative screenings such as the Ezra full-body MRI are so important. Early detection is the best way to prevent, treat, or cure cancer.
When an IPMN does present symptoms, they’re often similar to bile duct disorders. Sometimes, people with an IPMN will develop acute pancreatitis, and the uncomfortable symptoms may prompt them to see their medical provider.
Some symptoms could be caused by many conditions, so it might be hard to connect them to IPMNs. These include:
- Jaundice (yellow eyes or skin)
- Appetite loss or unexplained weight loss
- Fever and night sweats
- Abdominal pain on the right side of your body, which is home to the gallbladder, liver, and pancreas
- Severe and persistent heartburn and indigestion
- Stomach upset, nausea, vomiting, constipation, and diarrhea
Types of IPMNs that may affect your pancreas.
IPMNs are usually put into one of two categories:
- IPMNs associated with invasive cancer
- IPMNs where there is no invasive cancer present
IPMNs with no associated invasive cancer are placed into one of two subtypes:
- Low-grade dysplasia (LGD)
- High-grade dysplasia (HGD)
Dysplasia means the cell’s state is abnormal. In some cases, this might mean that the cell is pre-cancerous.
Over time, IPMNs may progress from low-grade to high-grade dysplasia. In the case of HGD, the disease may progress to invasive cancer.
IPMNs are further evaluated and classified according to their location in the pancreas:
- Main duct
- Branch duct
- Both the main duct and branch duct
IPMNs need to be classified to help make decisions around treatment.
How your medical practitioner looks for or treats an IPMN.
Many tests can help look for an IPMN or monitor one once it’s found.
Your medical provider might do a blood test to see if you have some of the markers of IPMN like jaundice, elevated white blood cells, abnormal levels of pancreatic and liver enzymes, or a tumor marker (CA 19-9), which is expected to show up in biliary tract disorders.
This non-intrusive screening test can reveal a narrowing within the common bile duct, which is a marker of IPMN.
Abdominal computed tomography (CT scan) or MRI.
A CT scan or abdominal MRI can identify narrowing within the biliary tract. Both scans are noninvasive procedures, during which the bile duct images are shown on a computer monitor.
Endoscopic ultrasound (EUS).
This endoscopy procedure involves a fine, flexible tube inserted into the small intestine known as your duodenum. From there, the ultrasound transducer can create detailed pictures of your pancreas and nearby abdominal organs.
Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA).
In some cases, a biopsy and endoscopy might be done to take a tissue sample. According to international guidelines in pancreatology, it is necessary for all BD-IPMNs that present specific “worrisome features” to have an endoscopic ultrasound-guided fine-needle aspiration.
Magnetic resonance cholangiopancreatography (MRCP).
An MRCP is a non-intrusive screening test that uses a strong magnetic field to look at your pancreas, liver, gallbladder, and bile ducts. This test may show if the bile ducts are obstructed, as they might be by a suspected IPMN.
Treatment options for IPMN.
Usually, observation is the only action taken for IPMNs. They are most often not considered to be at high risk for developing cancer.
Your medical provider will watch for IPMN growth by doing tests at regular intervals—every three months for larger cysts and annually for smaller branch IPMNs.
If there is a concern about invasive IPMN evolving into cancer, the only treatment is to remove part of the pancreas or, rarely, the entire pancreas. Since treatment typically involves surgery, the risks of treatment need to be weighed carefully against the possibility of cancer.
IPMNs of the main duct might be candidates for surgery more often than those found only in the branches. This is because IPMNs within the ductal branches are more difficult to treat and have been found to be less aggressive than main duct IPMNs.
There are three common types of pancreatic surgery to treat IPMNs:
- Distal pancreatectomy: This surgery removes a section from the pancreas body and from the tail of the pancreas, which is the part of the pancreas that is closest to the spleen. In some cases, your surgeon might also remove the spleen. Usually, enough of the pancreas is left that pancreatic function (the production of enzymes and hormones) will not be affected.
- Pancreaticoduodenectomy: Also called the Whipple procedure, this surgery removes the head of the pancreas when it contains IPMNs. Sometimes the duodenum, part of the bile duct, the gallbladder, and part of the stomach is removed as well.
- Total pancreatectomy: This is the procedure to remove the entire pancreas. Likewise, your surgical team will also remove the spleen, part of the stomach, and a portion at the beginning of the small intestine. This type of surgery is very rarely performed for IPMNs and only if the IPMN goes throughout the entire main duct. If the whole pancreas is removed, the stomach will need to be connected to the remaining section of the small intestine for digestion.
Early detection is key to detecting IPMN and preventing cancer.
The pancreas is responsible for essential body functions related to our digestive and endocrine systems. An IPMN is one of several actionable conditions that could happen to your pancreas.
IPMN causes pancreatic inflammation or pancreatitis. When this occurs, the cells that line our pancreatic duct (the area responsible for shuttling digestive enzymes to the duodenum) can become premalignant. In other words, there is a chance these cells could spiral into pancreatic cancer, a notoriously brutal type of cancer.
Most often, pancreatic cysts are not cancerous and can be readily managed, preventing cancer.